Hierarchical Taxonomy Of Psychopathology Model Research Articles

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI).

Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.

Symptom Checklist-90-Revised: Factor structure and relevance as a measure for the Hierarchical Taxonomy of Psychopathology model

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a recently proposed dimensional model of psychopathology that aims to provide a more comprehensive understanding of the organization of mental disorders. The Symptom Checklist-90-Revised (SCL-90-R) is a widely used self-report questionnaire that assesses nine broad dimensions of psychopathologies. The current study reexamined the optimum factor structure of the SCL-90-R (first aim), and its usefulness for the assessment of psychological dimensions from a HiTOP perspective (second aim). These were examined in a community sample of adolescents from Cyprus. A total of 839 adolescents (males = 352, females = 485; no response = 2) with ages ranging from 14 to 18 years [mean (SD) = 15.52 years (0.64 years)] completed the SCL-90-R and the Fünf-Faktoren-Fragebogen für Kinder (FFFK), a personality measure of the Five-Factor Model of personality. Relevant to the first aim, the findings showed the most support for an exploratory structural equal model, with the nine theorized SCL-90-R factors/dimensions. Relevant to the second aim, the SCL-90 dimensions of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety were associated with the five factors in the FFFK as theoretically predicated by the HiTOP model. The SCL-90-R dimensions for paranoid ideation and psychoticism did not. The findings indicated reasonable support for the theorized nine-factor SCL-90 model; and the use of the SCL-90-R dimension scales of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety for measuring the dimensions with similar names in the HiTOP model.

The hierarchical taxonomy of psychopathology in clinical high risk for psychosis: Validation and extension.

The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium's transdiagnostic dimensional model of psychopathology has considerable support; however, this model has been underresearched in individuals at clinical high risk for psychosis (CHR-P), a population that may advance the model. CHR-P individuals not only have attenuated psychotic symptoms that vary in severity, but also have many comorbid diagnoses and varied clinical outcomes, including disorders with uncertain relations to HiTOP (e.g., obsessive-compulsive disorder). The present study used self-report and interview data from North American Prodrome Longitudinal Study-3 (710 CHR, 96 controls) to replicate the HiTOP model and test specific hypotheses regarding disorders with uncertain relations to its dimensions. Additionally, the present study examined the HiTOP model in relation to childhood trauma, declines in social functioning, and development of full psychosis. Confirmatory factor analysis indicated that the HiTOP model's fit was nearly adequate (e.g., comparative fit index = .89), though several theory-relevant modifications were indicated. Additionally, specific tests were conducted to gain a more fine-grained perspective on how disorders with less clear prior evidence were related to the HiTOP model. Notable findings from these analyses include bipolar spectrum disorders relating to the psychosis super spectrum (i.e., .39 loading), and obsessive-compulsive disorder showing a complex pattern of loadings (e.g., internalizing and psychosis). The final model parsimoniously accounted for childhood trauma (e.g., super spectra rs = .22-.32), associations with current functioning, and predicted future conversion to a psychotic disorder (e.g., super spectra R² = .13). Overall, these results inform the HiTOP model and suggest its promise for CHR-P research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A detailed hierarchical model of psychopathology in Chinese clinical sample: Based on the SCL-90-R measure

ObjectiveThe Hierarchical Taxonomy of Psychopathology (HiTOP)model is an impressive effort to overcome shortcomings of traditional diagnostic systems. However, almost all of the quantitative empirical evidence used to structure the model comes from Western cultures and is built upon traditional diagnostic categories. This study aims to provide a detailed Chinese version of the HiTOP structure, ranging from symptoms based on The Symptom Checklist 90-R (SCL-90-R) up to the general factor. MethodsWe explored the detailed hierarchical structure of the SCL-90-R scale in adult (N = 34,222) and adolescent (N = 1973) clinical sample from Shanghai Mental Health Center, using extended bass-ackwards approach to draw the HiTOP model. ResultsThe Chinese HiTOP structure had a general factor at the top, 4 higher-order spectra (Internalizing, Externalizing, Broad Thought Disorder and Somatization and Somatic Anxiety) and 6 subfactors (Distress, Somatoform, Hostility, Fear, Psychosis and OCD) across both adult and adolescent samples. In addition, the adult sample contained 2 other subfactors: a) Sleep, and b) Suicide and Guilt. At the symptom level, some items were posited to components diverged from the original SCL-90-R subscales. ConclusionsThese findings offer the first description of the HiTOP structure in two Chinese samples and demonstrate that the SCL-90-R can be used to examine the HiTOP structure. The Somatization spectrum first emerged as a higher-order dimension, suggesting structural differences between Western and Eastern cultures. The results also suggest that transdiagnostic research should (1) further examine the positioning of somatoform symptoms using measures in other Eastern samples, and (2) place more emphasis on interpreting SCL-90-R results across different cultures.

Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP).

Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.

Meta-Analytic Review of Temperamental Correlates of the Five-Factor Model and Hierarchical Taxonomy of Psychopathology Domains.

There is little and heterogeneous knowledge on the links between the temperamental predispositions of psychopathology and the contemporary dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology (HiTOP) classification system, which can be aligned with the five-factor model (FFM) of personality. This meta-analysis seeks to expand the temperamental theoretical basis of the HiTOP model by incorporating associations of temperament traits of two temperamental theories measured, respectively, by the Temperament and Character Inventory (TCI) and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) with (a) the FFM's personality domains and (b) HiTOP's five psychopathological spectra. A systematic search was done on Web of Science, Scopus, PubMed, ProQuest, Cochrane Database, and Google Scholar for all articles published in English from January 1990 to August 2020. Because of heterogeneity in the results of almost 70% of studies, pooled estimates of correlation coefficients were calculated using the random-effects method. Risk of bias (low-quality studies) and publication bias are reported. The pooled correlations obtained from the analysis of 35 studies showed that the temperamental profile associated with each FFM domain and HiTOP spectra is distinct. Specifically, TCI-harm avoidance (HA) and all TEMPS temperaments were more strongly related to neuroticism/internalizing, extraversion/low detachment, and conscientiousness/disinhibition. In contrast, TCI-novelty seeking was more strongly related to both disinhibited/antagonistic externalizing and thought disorder. A large body of research supports maladaptive variants of all FFM domains and some psychopathological spectra of HiTOP related to the abnormal-range temperaments.

Diversity and the Hierarchical Taxonomy of Psychopathology (HiTOP)

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically based, hierarchical model of the structure of psychopathology that was created in response to the limitations of traditional, categorical psychiatric classification frameworks. The HiTOP model has become increasingly popular in clinical psychology and psychiatry since its publication in 2017. In this Review, we consider the applicability of the HiTOP model to diverse, underrepresented and epistemically excluded populations. We first review the philosophy underlying psychopathology research in general to understand the impact of scientific norms on the inclusion of diverse populations within the research canon. We then review the HiTOP approach to modelling psychopathology, and how diverse populations have been included within HiTOP-related research to date. We conclude by highlighting ways for future research to increase the applicability of the HiTOP framework to diverse populations. Seriously engaging with the HiTOP model’s suitability for diverse, underrepresented and epistemically excluded populations is imperative in order to achieve the HiTOP consortium’s goal of delineating a fully empirical classification of psychopathology, and to provide a model that can guide the field of psychopathology research and training to increase representation. The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically based, hierarchical model of the structure of psychopathology. In this Review, Rodriguez-Seijas et al. consider the applicability of the HiTOP model to diverse, underrepresented and epistemically excluded populations.

“One Metric to Rule Them All”: A Common Metric for Symptoms of Depression and Generalized Anxiety in Adolescent Samples

There is a significant degree of heterogeneity in scales that purport to measure depression and generalized anxiety in adolescent samples, which makes it difficult to directly compare scores across studies. The aim of the current study is to develop a common metric that facilitates the comparison of scores from different but related scales of depression and generalized anxiety using a large adolescent sample. A nonequivalent-anchor-test design in conjunction with simultaneous calibration was used to equate and develop a common metric for six different scales. The common metric provided scores with acceptable levels of precision across the −1 to 3 range on θ, which represents the more severe and often clinical end of the spectrum. Thus, in the current study, we identified a coherent common metric that is closely aligned with the “distress” subfactor of the Hierarchical Taxonomy of Psychopathology model. Additional validation testing in independent samples is now required.

Risk and resilience factors for psychopathology during pregnancy: An application of the Hierarchical Taxonomy of Psychopathology (HiTOP).

Pregnancy is a time of increased vulnerability to psychopathology, yet limited work has investigated the extent to which variation in psychopathology during pregnancy is shared and unshared across syndromes and symptoms. Understanding the structure of psychopathology during pregnancy, including associations with childhood experiences, may elucidate risk and resilience factors that are transdiagnostic and/or specific to particular psychopathology phenotypes. Participants were 292 pregnant individuals assessed using multiple measures of psychopathology. Confirmatory factor analyses found evidence for a structure of psychopathology consistent with the Hierarchical Taxonomy of Psychopathology (HiTOP). A common transdiagnostic factor accounted for most variation in psychopathology, and both adverse and benevolent childhood experiences (ACEs and BCEs) were associated with this transdiagnostic factor. Furthermore, pregnancy-specific anxiety symptoms most closely reflected the dimension of Fear, which may suggest shared variation with manifestations of fear that are not pregnancy-specific. ACEs and BCEs also linked to specific prenatal psychopathology involving thought problems, detachment, and internalizing, externalizing, antagonistic, and antisocial behavior. These findings extend the dimensional and hierarchical HiTOP model to pregnant individuals and show how maternal childhood risk and resilience factors relate to common and specific forms of psychopathology during pregnancy as a period of enhanced vulnerability.

The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research.

The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.

Childhood Imaginary Companion and Schizotypy in Adolescents and Adults

Objective: This study evaluated the association of Childhood Imaginary Companion (CIC) status and schizotypy levels of adolescents and adults within the framework of the Hierarchical Taxonomy of Psychopathology (HiTOP). Method: The sample included 255 Iranian adolescents and adults, grouped according to their CIC status, who responded mostly via e-questionnaires on a website. Schizotypy dimensions were compared between these two groups. Two measures compatible with the HiTOP model were also evaluated both in relation to the short scale of the Oxford-Liverpool Inventory of Feelings and Experiences (sO-LIFE) schizotypy dimensions and the CIC status of participants; one scale used exclusively with adolescents (i.e., the Achenbach System of Empirically-Based Assessment-Youth Self-Report [ASEBA-YSR]), and another with adults (i.e., the NEO-Five Factor Inventory [NEO-FFI]). Results: Scores on the unusual experiences (UnEx) the impulsive nonconformity (ImpNon) dimensions, and the total score of the sO-LIFE were higher for the CIC group. For adolescents, the UnEx dimension and the Thought Problems subscale of the ASEBA-YSR correlated. Scores on three subscales of the ASEBA-YSR (i.e., Thought Problems, Obsessive-Compulsive Problems, and PTSD Problems) were significantly higher for the CIC group. For adults, the neuroticism domain of the NEO-FFI correlated strongly with total score of the sO-LIFE and the cognitive disorganization (CogDis) dimension. This domain of the NEO-FFI was the only one in which CIC adults scored higher than the NIC group. Conclusion: CIC in adolescents and adults is associated with a set of schizotypy dimensions in line with the concept of the “happy schizotype.”

Somatoform's placement and validity in the hierarchical taxonomy of psychopathology (HiTOP)

Limitations of a polythetic-categorical classification system has sparked ongoing quantitative efforts to establish a valid and reliable method for diagnosing mental illness. Dimensional methods of classification, such as the Hierarchical Taxonomy of Psychopathology (HiTOP), have been found to ameliorate the limitations of a categorical approach – despite the provisional placement of a Somatoform spectrum. The current investigation sought to elucidate the placement of the Somatoform spectrum within the HiTOP model, and to further corroborate discriminant and convergent validity of the Somatoform spectrum. Using a sample of patients seeking chronic low-back pain treatment (n = 200), superior model fit suggested Somatoform fits better as a separate spectrum from Internalizing and placing Somatoform as a subfactor of Internalizing did not improve model fit. Discriminant and convergent validity with an external criteria demonstrated distinctiveness of the Somatoform spectrum from the Internalizing spectrum in the HiTOP model.

Reconceptualizing schizophrenia in the Hierarchical Taxonomy Of Psychopathology (HiTOP)

The concept of schizophrenia, operationalized in diagnostic manuals, faces existential challenges of low reliability, arbitrary boundaries, overlap with other disorders, and heterogeneity. The Hierarchical Taxonomy Of Psychopathology (HiTOP) was developed to address these challenges. It conceptualizes psychotic disorders as continuous with normality. To alleviate heterogeneity, psychotic disorders are decomposed into 14 tightly-knit symptom and trait dimensions. These narrow dimensions form two broader spectra-psychoticism (e.g., positive symptoms, peculiarity, fantasy-proneness) and detachment (e.g., negative symptoms, emotional detachment, romantic disinterest)-that comprise the psychosis superspectrum. The full HiTOP model includes four other spectra that can be useful in a comprehensive evaluation. This model is undergoing rigorous validation. It has shown greater reliability, explanatory power, and prognostic value than schizophrenia diagnosis. The HiTOP approach produced promising evidence of clinical utility in surveys of clinicians. The HiTOP reconceptualization of schizophrenia suggests four major implications. First, schizophrenia spans two spectra, and therefore detachment is important to study including in people who have never been psychotic. Second, large population-based studies with comprehensive profiling of psychopathology can address shortcomings of case-control design. Third, elevations on psychoticism and detachment dimensions early in life offer opportunities for prevention. Fourth, actionable ranges can be identified on dimensions to guide specific clinical decisions. The elaborate HiTOP model may be unnecessary in acute treatment settings, but it can benefit prevention, long-term management, and research. The categorical schizophrenia concept offers valuable continuity and can be used in parallel with HiTOP, but we predict that eventually the dimensional approach will make this category obsolete.

The prognostic utility of personality traits versus past psychiatric diagnoses: Predicting future mental health and functioning.

Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically-relevant outcomes. The current study directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (ΔR2=06-.15), symptom chronicity (ΔR2=.03-.06), and functioning (ΔR2=.02-.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings, beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with HiTOP model.

Measuring pathological traits of the schizotypal personality disorder through the HiTOP model

Schizotypal personality disorder (STPD) is characterized by difficulties in intimate relationships, social and interpersonal deficits, and perceptual distortions. Encompassing this personality disorder and other mental conditions, the Hierarchical taxonomy of psychopathology (HiTOP) is an evidence-based, dimensional model covering pathological traits in its lower range. This study aimed to develop a self-report scale for screening pathological traits of STPD from the perspective of the HiTOP. The sample consisted of 474 Brazilian adults aged 18-70 years who answered the developed scale, the IDCP-STPD, facets of the Personality Inventory for DSM-5 (PID-5), and factors of the Computerized Adaptive Assessment of Personality Disorder Static Form (CAT-PD-SF). The scale was composed of 73 items distributed in two factors. Internal structure reliability was higher than 0.80 for all scores of the scale. The factors showed associations with the expected external measures, and the groups based on the STPD external measures (healthy and pathological) showed big to huge differences. Although initial, our findings suggested the IDCP-STPD as a helpful measure to the clinical context to screen the STPD pathological traits. Moreover, the structure observed for the IDCP-STPD confirms the spectrum level of the HiTOP.

A Hierarchical Taxonomy of Psychopathology (HiTOP) Primer for Mental Health Researchers

Mental health research is at an important crossroads as the field seeks more reliable and valid phenotypes to study. Dimensional approaches to quantifying mental illness operate outside the confines of traditional categorical diagnoses, and they are gaining traction as a way to advance research on the causes and consequences of mental illness. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a leading dimensional research paradigm that synthesizes decades of data on the major dimensions of psychological disorders. In this article, we demonstrate how to use the HiTOP model to formulate and test research questions through a series of tutorials. To boost accessibility, data and annotated code for each tutorial are included at OSF ( https://osf.io/8myzw ). After presenting the tutorials, we outline how investigators can use these ideas and tools to generate new insights in their own substantive research programs.

Development of Measures for the Hierarchical Taxonomy of Psychopathology (HiTOP): A Collaborative Scale Development Project.

In this article, we describe the collaborative process that is underway to develop measures for the Hierarchical Taxonomy of Psychopathology (HiTOP). The HiTOP model has generated much interest in the psychiatric literature in recent years, but research applications and clinical translation of the model require measures that are specifically keyed to the model. To that end, the Measures Development Workgroup of HiTOP has been engaged in a collaborative effort to develop both questionnaire and interview methods that (a) are specifically tied to the elements of the HiTOP structure, and (b) provide one means of testing that structure. The work has been divided among five subgroups that are focused on specific HiTOP spectra. Our scale development methods are rooted in the principles of construct valid scale development. This report describes Phase 1 of this project, summarizes the methods and results thus far, and discusses the interplay between measurement and HiTOP model revisions. Finally, we discuss future phases of the scale development and the steps we are taking to improve clinical utility of the final measures.

The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence.

Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.

The utility of hierarchical models of psychopathology in genetics and biomarker research.

The utility of hierarchical models of psychopathology in genetics and biomarker research.

Revealing what is distinct by recognising what is common: distinguishing between complex PTSD and Borderline Personality Disorder symptoms using bifactor modelling

ABSTRACT Background: Despite concerns of conceptual similarity, increasing evidence supports the discriminant validity of Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD). However, all studies to date have assumed a categorical model of psychopathology. In contrast, dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology model (i.e. HiTOP model), recognise shared vulnerability across supposedly discrete disorders. Accounting for shared vulnerability between CPTSD and BPD symptoms may help to better reveal what is unique about these constructs. Objective: To identify the distinct and shared features of CPTSD and BPD via the application of dimensional modelling procedures. Method: Confirmatory bifactor and confirmatory factor analysis were employed to identify the optimal latent structure of CPTSD and BPD symptoms amongst a convenience sample of Israeli adults (N = 617). Additionally, structural equation modelling was used to identify risk factors associated with these constructs. Results: The latent structure of CPTSD and BPD symptoms was best explained by a bifactor model including one ‘general’ factor (i.e. vulnerability to all symptoms) and three ‘specific’ correlated factors (i.e. vulnerability to PTSD, DSO, and BPD symptoms, respectively). CPTSD symptoms were more readily distinguished from the general factor whereas BPD symptoms were not as easily distinguished from the general factor. CPTSD symptoms reflecting a negative self-concept and BPD symptoms reflecting an alternating self-concept were the most distinctive features of CPTSD and BPD relative to the general factor, respectively. Most of the risk factors were associated with the general vulnerability factor, consistent with the predictions of dimensional models of psychopathology regarding shared risk across supposedly distinct psychiatric constructs. Conclusion: Consistent with a dimensional model of psychopathology, CPTSD and BPD shared a common latent structure but were still distinguishable. CPTSD and BPD symptoms may be most effectively distinguished based on the phenomenology of self-concept symptoms.